Provider Demographics
NPI:1225013378
Name:GOTTESMAN, SUSAN RS (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RS
Last Name:GOTTESMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:MSC 37
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-2744
Mailing Address - Fax:718-270-4567
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:MSC 37
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-2744
Practice Address - Fax:718-270-4567
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177948-1207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02544865Medicaid
NY24K881Medicare ID - Type Unspecified
NY02544865Medicaid